Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants?
Abstract
:1. Introduction
2. Methods
Statistical Analyses
3. Results
4. Discussion
4.1. Strengths
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Diagnostic Criteria | Normal or Mild Impairment | Moderate Impairment | Severe Impairment |
---|---|---|---|
Cognitive | BSID-III cognitive composite score >85 | BSID-III cognitive composite score 70–85 | BSID-III cognitive composite score <70 |
Motor | BSID-III motor composite score >85 or No diagnosis of CP or mild CP (GMFCS 0, 1) | BSID-III motor composite score 70–85 or Diagnosis of CP with GMFCS level 2 (walks with orthotics) | BSID-III motor composite score <70 or Diagnosis of CP with GMFCS level 3–5 (walks using a hand-held mobility device or self-mobility with a powered mobility device or transported in a manual wheelchair) |
Language | BSID-III language composite score ≥85 | BSID-III language composite score 70–84 | BSID-III language composite score <70 |
Vision | Mild visual impairment (visual acuity better than 20/200 in both eyes) | Bilateral blindness (visual acuity less than 20–200 in the strongest eye) | Bilateral blindness that cannot be corrected |
Hearing | Mild hearing impairment (not requiring amplification or requiring amplification in just one ear) | Bilateral hearing loss (requiring amplification) | Severe to profound hearing impairment (no functional hearing with amplification) |
Gestational Weeks | ||||
---|---|---|---|---|
Maternal Characteristics and Morbidity among Mothers for Surviving Infants | 23 Weeks (n = 48) | 24 Weeks (n = 246) | 25 Weeks (n = 383) | 26 Weeks (n = 433) |
Maternal age, mean (SD) | 29.94 (5.46) | 30.62 (5.51) | 30.68 (6.07) | 30.46 6.08) |
Gravidity, mean (SD) | 2.79 (1.95) | 2.52 (1.66) | 2.61 (1.92) | 2.49 (1.72) |
Maternal Education, n (%) | ||||
Less than grade 12 equivalent | 9 (20.0) | 23 (10.6) | 27 (7.8) | 37 (9.9) |
High school graduate | 13 (28.9) | 53 (24.4) | 66 (19.2) | 91 (24.3) |
Some post-secondary degree | 12 (26.7) | 41 (18.9) | 66 (19.2) | 78 (20.8) |
University/graduate degree | 11 (24.4) | 100 (46.1) | 185 (53.8) | 169 (45.1) |
Unknown | 3 (6.0) | 29 (12.0) | 39 (10.0) | 58 (13.0) |
Single parent family, n (%) | 6 (13.6) | 20 (9.4) | 32 (9.3) | 35 (9.4) |
Obesity (weight > 91 kg), n (%) | 0 (0.0) | 10 (4.1) | 9 (2.4) | 15 (3.5) |
Pre-pregnancy hypertension, n (%) | 0 (0.0) | 2 (0.8) | 10 (2.6) | 14 (3.2) |
PIH, Gestational hypertension, Pre-eclampsia, n (%) | 0 (0.0) | 8 (3.3) | 27 (7.1) | 57 (13.2) |
Assisted conception, n (%) | 8 (17.0) | 53 (21.7) | 55 (14.4) | 68 (15.7) |
Smoking during pregnancy, n (%) | 7 (14.6) | 25 (10.2) | 43 (11.3) | 54 (12.5) |
Alcohol use during pregnancy, n (%) | 1 (2.1) | 13 (5.3) | 12 (3.1) | 11 (2.5) |
Multiple births, n (%) | 13 (27.1) | 66 (26.9) | 97 (25.3) | 112 (25.9) |
Antenatal corticosteroids, n (%) | 36 (76.6) | 222 (90.2) | 353 (92.4) | 391 (90.9) |
PPROM > 24 h, n (%) | 16 (34.0) | 61 (24.9) | 110 (28.9) | 117 (27.0) |
Chorioamnionitis, n (%) | 15 (31.2) | 84 (34.1) | 130 (34.1) | 114 (26.3) |
Antepartum hemorrhage, n (%) | 14 (29.2) | 74 (30.1) | 93 (24.5) | 116 (26.8) |
Outborn, n (%) | 14 (29.2) | 45 (18.3) | 64 (16.70 | 89 (20.6) |
Caesarean birth, n (%) | 11 (22.9) | 126 (51.2) | 204 (53.3) | 256 (59.1) |
Neonatal Characteristics and Morbidity of Surviving Infants | 23 Weeks (n = 48) | 24 Weeks (n = 246) | 25 Weeks (n = 383) | 26 Weeks (n = 433) |
Birth weight, mean (SD) | 591.77 (65.14) | 677.00 (90.22) | 766.97 (104.00) | 866.25 (152.73) |
Small for gestational age, n (%) | 3 (6.2) | 14 (5.7) | 13 (3.4 | 43 9.9 |
Female, n (%) | 23 (47.9) | 122 (49.6) | 202 (52.7) | 203 (46.9) |
Necrotizing enterocolitis (≥Bell stage 2), n (%) | 7 (14.6) | 28 (11.4) | 48 (12.5) | 37 (8.5) |
Retinopathy of prematurity, n (%) | ||||
Stage 3 | 28 (58.3) | 92 (37.7) | 75 (19.6) | 40 (9.3) |
Stage 4, 5 | 0 (0) | 1 (0.4) | 1 (0.3) | 0 (0) |
Sepsis (culture-proven), n (%) | 26 (54.2) | 96 (39.3) | 113 (29.6) | 102 (23.6) |
Intraventricular hemorrhage, n (%) | ||||
Grade 1 | 13 (27.1) | 54 (22.0) | 77 (20.1) | 70 (16.2) |
Grade 2 | 6 (12.5) | 29 (11.8) | 47 (12.3) | 29 (6.7) |
Grade 3 | 4 (8.3) | 11 (4.5) | 16 (4.2) | 16 (3.7) |
Grade 4/periventricular venous infarct | 7 (14.6) | 32 (13.1) | 34 (8.9) | 21 (4.8) |
Periventricular leukomalacia, n (%) | 2 (4.2) | 5 (2.0) | 17 (4.4) | 14 (3.2) |
Hypotension requiring inotropes, n (%) | 31 (64.6) | 87 (35.5) | 92 (24.0) | 82 (18.9) |
Bronchopulmonary dysplasia, n (%) | 38 (79.2) | 158 (65.0) | 183 (48.3) | 154 (36.7) |
Days of respiratory support, median (IQR) | 78.50 (62.00, 89.50) | 66.00 (54.00, 84.00) | 56.00 (43.00, 69.00) | 43.00 (32.00, 55.00 |
Postnatal corticosteroids, n (%) | 17 (35.4) | 58 (23.6) | 53 (13.8) | 30 (6.9) |
Length of stay (days) for initial hospitalization, median (IQR) | 127.00 (116.50, 139.50) | 118.00 (106.00, 134.00) | 104.00 (91.00, 123.00) | 90.00 (78.00, 103.00) |
Gestational Weeks | ||||
---|---|---|---|---|
Neurodevelopmental Characteristics | 23 Weeks (n = 45) | 24 Weeks (n = 224) | 25 Weeks (n = 360) | 26 Weeks (n = 383) |
Growth | ||||
Head circumference, mean (SD) | 46.26 (1.67) | 46.53 (1.70) | 46.93 (1.82) | 47.24 (0.72) |
Weight, mean (SD) | 10.17 (1.50) | 10.19 (1.52) | 10.56 (1.52) | 10.76 (1.57) |
Height, mean (SD) | 80.19 (3.77) | 80.07 (3.40) | 80.27 (2.99) | 80.84 (3.46) |
Post-discharge morbidity, n (%) | ||||
Discharged home on oxygen | 26 (57.8) | 92 (41.1) | 87 (24.2) | 77 (20.1) |
Gastrostomy tube feedings | 7 (15.9) | 18 (8.1) | 18 (5.0) | 12 (3.1) |
Hospitalization | 18 (40.0) | 90 (40.2) | 126 (35.0) | 103 (27.0) |
Need for recurrent medications | 16 (37.2) | 64 (29.1) | 84 (23.7) | 74 (19.7) |
Seizure disorder | 1 (2.4) | 7 (3.2) | 8 (2.3) | 2 (0.5) |
Ventriculoperitoneal shunt | 1 (2.2) | 11 (4.9) | 13 (3.6) | 6 (1.6) |
BSID-III Measures | ||||
BSID-III completion, n (%) | 33 (73.3) | 175 (78.10) | 303 (84.2) | 330 (86.2) |
Cognition composite score, mean (SD) | 85.38 (15.06) | 88.63 (14.45) | 92.51 (13.95) | 94.08 (12.35) |
median (IQR) | 90.00 (80.00, 95.00) | 90.00 (80.00, 100.00) | 95.00 (85.00, 100.00) | 95.00 (85.00, 105.00) |
Language composite score, mean (SD) | 77.43 (16.16) | 83.09 (16.97) | 87.72 (15.46) | 87.79 (14.99) |
median (IQR) | 74.00 (66.50, 92.50) | 84.50 (71.00, 94.00) | 89.00 (77.00, 100.00) | 89.00 (77.00, 100.00) |
Motor composite score, mean (SD) | 82.69 (16.75) | 88.50 (14.13) | 91.68 (13.15) | 92.77 (12.41) |
median (IQR) | 88.00 (70.00, 95.50) | 94.00 (82.00, 97.00) | 94.00 (85.00, 100.00) | 94.00 (85.00, 100.00) |
Neurosensory/Neuromotor | ||||
Hearing Impairment, n (%) | ||||
Mild | 2 (4.4) | 13 (5.8) | 8 (2.2) | 5 (1.3) |
Severe | 1 (2.2) | 14 (6.3) | 14 (3.9) | 8 (2.1) |
Vision Impairment, n (%) | ||||
Mild | 15 (33.33) | 36 (16.1) | 19 (5.3) | 16 (4.2) |
Severe | 1 (2.2) | 6 (2.7) | 9 (2.5) | 5 (1.3) |
Motor Impairment (Cerebral palsy), n (%) | ||||
None | 39 (86.7) | 190 (87.6) | 318 (90.3) | 356 (93.9) |
Mild (GMFCS 1, 2) | 2 (4.4) | 8 (3.7) | 23 (6.6) | 15 (4.0) |
Moderate/severe (GMFCS 3, 4, 5) | 4 (8.8) | 19 (9.13) | 11 (3.1) | 8 (2.2) |
Gestational Age (Weeks) | Outcome n (%) | p-Values | |||
---|---|---|---|---|---|
No Impairment | NDI β | SNI * | |||
23 | Full Early split Late split | 14 (37.8) 2 (13.3) 12 (54.5) | 10 (27.0) 5 (33.3) 5 (22.7) | 13 (35.1) 8 (53.3) 5 (22.7) | 0.034 |
24 | Full Early split Late split | 94 (49.0) 51 (45.9) 43 (53.1) | 55 (28.6) 34 (30.6) 21 (25.9) | 43 (22.4) 26 (23.4) 17 (21.0) | 0.615 |
25 | Full Early split Late split | 202 (65.0) 111 (63.8) 91 (66.4) | 66 (21.2) 39 (22.4) 27 (19.7) | 43 (13.8) 24 (13.8) 19 (13.9) | 0.841 |
26 | Full Early split Late split | 227 (69.0) 127 (65.1) 100 (74.6) | 77 (23.4) 53 (27.2) 24 (17.9) | 25 (7.6) 15 (7.7) 10 (7.5) | 0.138 |
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Asztalos, E.; Aguirre, A.N.; Hendson, L.; Church, P.; Banihani, R.; van Dyk, J.; Zein, H.; Thomas, S. Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants? Children 2021, 8, 731. https://doi.org/10.3390/children8090731
Asztalos E, Aguirre AN, Hendson L, Church P, Banihani R, van Dyk J, Zein H, Thomas S. Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants? Children. 2021; 8(9):731. https://doi.org/10.3390/children8090731
Chicago/Turabian StyleAsztalos, Elizabeth, Alberto Nettel Aguirre, Leonora Hendson, Paige Church, Rudaina Banihani, Jessie van Dyk, Hussein Zein, and Sumesh Thomas. 2021. "Does a Split-Week Gestational Age Model Provide Valuable Information on Neurodevelopmental Outcomes in Extremely Preterm Infants?" Children 8, no. 9: 731. https://doi.org/10.3390/children8090731